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*-SNIA'NAJ$#[ <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(7r4) 647.s800 <br />www santi-ana.otq <br />rNSP-02 20 r3 CRa <br />fhis document moy be found ot htiCt i',1r!,/v santa-ana.erqipbai <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:3cr t S c <br />Permit Number: j l0 l q'3 ?? 3 <br />Contractor:License #: <br />State of Caljfornia requlres that smoke and carbon monoxide {CO) alarms are installed in resident,al <br />bu ild ing s. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R31.4.3 and R314.3.3 define <br />the required loca tions. <br />f,\ eotrr boxes below must be checked: <br />{Carbonmonoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling. Aiarms are required in bedrooms with gas-fired <br />appllances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E{moke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life rnust be 10 year!. <br />I hereby certify that I am the contractor or the prooerty owner of the above project. lfurther certify <br />that smoke alarms and carbon monoxide aiarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />manuf acturer's instructions. <br />Signature:Do te <br />lcheck onel tr L rcense d ontr c ar d--Pro perty \ivner <br />NOTE: fhis sef-c ertification is only used t'or projects that dlfect the ErTERIOR of the structure. This <br />process is opplicoble ONLY to projects where access to the interior of the dwelling by d Sonta Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspectionl <br />Smoke & CO <br />Alarm Affidavit <br />PropertyOwner: N_-\.,S,.^ Q.,,_.r.-, <br />I